Incrementalism Advocacy

In that light, while Obamacare is not the best option, it is the best option that was attainable given a corrupt Congress and a corrupt political process. It is imperative that Americans enroll in the exchanges. It is imperative that Obamacare as a first step in our health care reform is marginally successful.

While it is not spoken about much, Obamacare is the first step on a path toward a single-payer system. Those on the left that are upset that it isn’t a single payer system already must stay in the game. They must continue to fight for single payer. That said, they should not be fighting against this law because it was not their ideal or because in the initial stages of this law private insurance companies will still reap an unearned profit from skimming. Battles are won either incrementally or revolutionarily. The second option is simply not in the current American DNA. As such all must play the long game. HR 676 will be a closer reality if Obamacare is effected.

This is a false choice. It it not an either or situation. The situation is whatever we make it. Reducing health care work to an either/or choice creates an absurdly simple view to a very complex problem.

I characterize people who advocate this position “incrementalists”. And here is my biggest problem with them: what is the strategy in this amorphous “long game”? What steps take us from our current position to single payer health care, which every other industrialized nation on earth except the U.S. implements? There are never any steps, strategies, or tactics that take us from here to there. I adapt a common argument used on DKos:

1. Obamacare

2. ???

3. Single payer! Yay!

Incrementalists make excuse after excuse after excuse, all the while apologizing for all the people who are immersed in the aforementioned corrupt system, but then lecture folks who oppose Obamacare because it was written by industry and not by other health policy entities. Futhermore, Obamacare doesn’t ensure health care to all people, just health insurance to some more people. It took 18 months for the incrementalists to capitulate to industry and the political establishment, after which the Democratic base sat out the 2010 elections. Historically, we address health care legislation once per generation. In 25 years, what steps will we take toward single payer, if that is really the goal of the incrementalists? How many generations need wait until we implement a 20th century health care system? In the meantime, what improvements to today’s system will the rest of the industrialized world implement?

Going back to that first paragraph, let’s highlight the following. “It is imperative that Americans enroll in the exchanges.” If this were true, why didn’t the Obama administration work to make sure Americans were ready to enroll come tomorrow? They’ve only had three years to figure out an enrollment strategy that is absolutely critical to the entire program’s success and implement it. What were they doing? Incremental work, I suppose. Which is why 60+% of Americas have no idea what tomorrow’s open enrollment consists of.

“It is imperative that Obamacare as a first step in our health care reform is marginally successful.”

Really? 18 months of negotiation, three years of shoddy implementation, and the best the author can come up with is it’s imperative Obamacare is only marginally successful?! The insurance companies get 30 million new customers (read: profits) and the best we can do is marginal success? Millions of Americans are shut out from Obamacare because they have the misfortune of Teabagger governorship, but marginal success is incrementally better than no success, right? It is this blind acceptance of sub-par results that lays the foundation for incrementalists. I expect more from my country and fellow Americans. Unfortunately, I am part of a minority. The majority accepts mediocrity as the best they can achieve.

We are not in disagreement at all. I am an incrementalist not by choice but by reality. Until we find some way to educate Americans so that fallacies that are metastasized now are eradicated we can choose nothing or choose something that help as many as possible. I can tell you categorically that I know too many even this much less than optimal law have provide orders of magnitude better than they currently have.

Now we should all be willing to continue the fight in the correct direction, single payer, instead of creating a divide among those who want to get there and must be allies.

Thanks for replying!
I think operating from an information deficit paradigm is not useful in health care anymore than it is in climate change or any other issue. Conservatives continue to successfully operate using value frames – a strategy that other groups ignore, then feel compelled to fall back to their information deficit paradigm.
I agree with your direction. I would love to hear about proposed strategies to get there.